Getting Active after Covid 19 Illness

With the recent increase in Covid 19 cases due to Delta and Omicron variants, some patients and active individuals are asking about the timing for safely returning to sports after recovering from Covid 19 infection.  While there is consensus guidance on this that we’ll discuss, the individualized approach is more nuanced and needs tailoring to each person.  Reasons for a personalized approach include the individual athlete’s age, sport, medical history, and Covid 19 symptoms and severity of illness.  For example, if a 16 year-old healthy basketball player who tested Covid positive and only has brief symptoms of headache and sore throat for 48 hours, then feels better, they may be able to get active sooner than another 16 year-old basketball player who tested Covid positive and experienced chest pain, fever, shortness of breath, and muscle aches for several days before their symptoms improved. 

There can be many different Covid 19 recovery scenarios because everyone has a unique immune system, medical history, and response to Covid 19 that can affect the timing for safe return to sports activity.  Some individuals may experience only mild Covid 19 symptoms, whereas others are recovering from moderate to severe illness. 

The most important consideration for return to sport after Covid 19 illness has to do with the function of the heart and lungs.  Heart inflammation (myocarditis) can occur with Covid 19 illness and increase the risk of a cardiac event such as an arrythmia for days to weeks after testing positive for Covid 19.  Arrythmias can be very dangerous and may occur without warning.  Feeling tired (Fatigue) is also common for days to weeks after becoming ill with Covid 19.  The good news is that most individuals who become ill with Covid 19 recover without adverse effects on their heart or lungs.  However, it is important to talk to your sports medicine doctor about safely returning to sport.  It is especially important to seek guidance from your doctor if you have experienced a moderate to severe Covid 19 illness or required hospital support for Covid 19.

Several countries and sports medicine organizations, like the American Medical Society for Sports Medicine (AMSSM) have created guidance protocols for return to play after Covid 19.  The main reason for this graded return to play protocol is to try to reduce the risk of a cardiac event from myocarditis and to allow the athlete several days to ramp up their endurance after illness.  In a study published in JAMA (Journal of the American Medical Association) Cardiology May 27, 2021, it showed a 2.3% prevalence of myocarditis in college athletes who tested positive for Covid 19 and underwent cardiac mri.  While most did not experience symptoms of chest pain, myocarditis can adversely affect the heart’s pumping ability and increase the risk of arrythmias and even sudden cardiac death. 

For high school athletes In Portland, the Oregon School Activities Association (OSAA) has created guidance for return to sports after Covid 19 infection.  Those who were asymptomatic or only had mild Covid 19 symptoms should rest for a minimum of 3 days after symptoms started or testing positive and recover fully.   After that, they can advance back to activity over a minimum of 3 days.  Those who experienced moderate Covid 19 symptoms such as fever, chills, prolonged symptoms, or hospitalization should see a physician like a sports medicine specialist or cardiologist prior to return to sports activity.  Their physician may consider additional testing based on age and symptoms.  If you recently were diagnosed with Covid 19 and have questions or concerns about returning to sports activity, don’t hesitate to schedule a consultation today

Author

David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.